By Bruce Gosser
Overburdened and inefficient. An accurate description of today’s US healthcare system which wasn’t designed to handle the current population’s health needs. According to the Centers for Disease Control and Prevention (CDC), 68 percent of Americans aged 65 and older are living with multiple chronic conditions. With this expanding population of chronic patients, there’s a need to re-visit our current models.
Technology solutions in healthcare, such as remote patient monitoring (RPM), can help bridge the gap between the overtaxed medical resources and the growing demand for them. While virtual care technology like RPM has been around for years, there have been many barriers to adoption: clinician mindset, regulatory, technological/interoperability issues and most important: how to reimburse clinicians for care. However, current healthcare reforms are finally changing the game.
Value-Based Reimbursement Incentives
In January 2018, Centers for Medicaid and Medicare Services (CMS) announced changes to Medicare reimbursement for remote patient monitoring and telemedicine. By introducing the new CPT code 99091, clinicians can now bill separately for time spent on collection and interpretation of health data that is generated by patients remotely. Before January of this year, RPM services were only reflected as a part of other payments, such as an office visit or chronic care management or transitional care management. Now, physicians can bill for remote monitoring in addition to those other fees. This means significant new revenue for physicians and is clearly based on the return on investment for CMS and other payers when patients are remotely monitored for serious chronic conditions like hypertension, diabetes, congestive heart failure, etc.
This direct new 99091 code and its financial incentive may finally ignite more widespread use of virtual telehealth and RPM resulting in increased access to healthcare services for those that need it most, at a lower cost of care and increased quality. The benefits are many: identifying at-risk patients, improving outcomes, and ultimately becoming part of the standard of care that improves the health and efficiency for all. Virtual telehealth technologies let patients take an active role in their health and allow providers to detect problems early before costs and complications escalate. The new and changing payment for remote patient monitoring is expected to boost the efforts of physicians and health systems to improve the health of chronic patient populations. At last, physicians will have meaningful technology available to support their transition to value-based care.
CMS Financial Incentives are in Place – Now What?
With CMS financial incentives now in place, there are other fundamentals that healthcare organizations should look at when trying to roll out virtual care and RPM program. These include:
The Right Technology
First, it is important that healthcare organizations interested in embarking on telehealth initiatives implement technology that captures and communicates the right data between the patient and the care team. This technology needs to be easy to use, deploy, and maintain.
According to a 2017 Aruba report, almost 60 percent of healthcare organizations have introduced IoT devices into their facilities with 87 percent of planning to implement medical IoT devices by 2019. Seventy-three percent of healthcare organizations use IoT for monitoring and maintenance with the most common use being patient monitoring at 64 percent.
The medical device IoT explosion and proliferation of wireless networks offers an overwhelming array of data gathering and communication solutions for healthcare. Bluetooth-enabled blood pressure cuffs and weight scales, implantable continuous glucose monitors, and smartphone apps that assess mood, pain control, or medication side effects allow people with hypertension, diabetes, or depression to engage in care safely, effectively, and virtually. Analytic tools help care teams know which patients need attention when and why.
Questions to consider to ensure you’re implementing the right technology:
What data do care teams need in order to monitor patients outside of the hospital or provider office?
What is needed for patients and care teams to communicate in the simplest manner?
What infrastructure is required?
Patient engagement and adherence is one of the most essential steps for implementing a successful telehealth program. Virtual care offers the opportunity to engage people “in the wild,” wherever they are living, not only in the physical setting of a provider organization. Helping patients manage their diabetes while at home, surrounded by their own personal challenges like eating the right foods or finding time to exercise, can powerfully reveal the barriers patients face with diabetes control; however, this only helps if the patients are ready and able to take responsibility for self-management.
Questions to consider to promote engagement:
How will you organizations generate awareness for its telehealth program?
Will you post signs around the office?
Will you send an email blast, or add a message to the office voice mail?
A New Model of Healthcare
The Center for Disease Control and Prevention estimates that medications are not taken as prescribed by their doctor 50 percent of the time. Close to one-third of American patients choose to ignore their doctor’s orders and forgo even filling their prescription at their pharmacy. This lack of adherence causes roughly 125,000 deaths each year and costs healthcare professionals a fortune. How can we get patients to follow their medication guidelines?
Virtual care offers new ways for patients to engage with their care and care teams, offering opportunities for education, treatment, and coordination of care. However, for this to occur successfully, it’s important for healthcare organizations to implement new healthcare models that integrate and take advantage of the interdisciplinary patient interactions that occur with or without the face-to-face provider visit. Other industries such as banking and retail have been able to make the transition to remote based models, it’s time for the healthcare industry to do the same thing.
Questions to consider when integrating telehealth into your healthcare organization
What goals are you trying to accomplish with virtual telehealth/RPM?
What is your current workflow and how will you integrate telehealth into that workflow
How will you engage your staff and make sure they’re on board?
Virtual care is destined to be the standard of care in healthcare as more organizations get familiar with the new way of thinking, new models and technology. Telehealth technologies have become financially viable to rapidly proliferate and positively change the way healthcare is delivered. As primary care physicians and other practices couple the new virtual telehealth technologies code with the existing Chronic Care Management codes and the Transitional Care Management codes, the new revenue will significantly transform these practices in terms of revenue and resources to serve our communities.